MORE CLINICAL LEARNING FOR NURSES

Updated 10 /25

Dear nurses,

It is a pleasure to share my years of clinical
learning with new and inexperienced nurses.
Sometimes, the clinical setting can be viewed
as being of less value than high scores in the
classroom. 

However, after decades of experience in clinical
areas such as : ER, ICU, CCU, PACU , I cherish
all that I have witnessed and been a part of. 

I have continued to add many topics in the clinical
setting that can be of great value to any nurse.

Diabetes mellitus, if not well managed,
may be further complicated by conditions
such as cardiovascular disease, stroke,
Retinopathy, Neuropathy and PVD. 

What is PVD?
Peripheral Vascular Disease (PVD) is caused
by poor circulation. The diabetic patient is at
risk for this condition.

Gangrene resulting from poor circulation and
may lead to surgical  intervention such as amputation.

The image above shows a nurse trying to do
a math calculation. Please take a moment to
 read and understand what this is about.

Using Decimals  
Have a good day.

Learn more : Safe medication administration

WHAT IS WRONG WITH THIS EKG ? - ADDRESSING V-TACH

Updated 8 /25

Dear nurses,

In the scenario shown above, a young man is found
near the lake. Someone calls 911 and rescuers arrive
to start resuscitation. An assessment shows, he is breathing
and has a weak pulse. 

What is Ventricular Tachycardia ?

Ventricular Tachycardia is an EKG arrhythmia which is 
life threatening. An assessment may or may not reveal a
pulse. If there is no pulse, it is treated the same as
ventricular fibrillation.

Causes include: 

Coronary artery disease, myocardial infarction, electrolytes
imbalances and more. Treatment and intervention is directed
at the cause. AHA has guidelines in place, for treating

Ventricular tachycardia.

Learn about : the ABG and Code Blue

UNDERSTANDING VENTRICULAR TACHYCARDIA

Updated 9/25

Dear nurses,

The EKG Series is no longer available.

The image above demonstrates Ventricular Tachycardia.
Learn more by clicking on the link: Ventricular Tachycardia

It takes " all hands on deck" when an emergency occurs.
Learn more about: Hemodynamic Monitoring and

Cardiac Assessment.

Scenario: Mrs. R is a 48 year-old female who has a history
of a previous myocardial infarction. She was admitted 2 days
 ago with mild chest pain. She was resting comfortably when
she suddenly started feeling short of breath. She is anxious 
and calls the nurse.

What actions did the nurse take?
-The nurse reassures Mrs. R. She does an assessment, vital signs
, and oxygen saturation. She gives oxygen per protocol.

-The nurse notifies the doctor of what has occurred and her
assessment findings. She also mentions the vital signs, low
oxygen saturation, and steps that were taken to correct the
saturation. The doctor gives further orders, including a
transfer to CCU.

Why chest pain assessment?

It must be remembered that a patient with heart damage
 will also experience chest pain. Assessment of the pain
should also be included. This may be sharp, with radiation
 to the shoulder/jaw, or it may feel like chest pressure.

Helpful Hint:
Chest pain should always be assessed.
 Enjoy learning more about this topic by clicking on the link:
Simplifying Cardiogenic Shock

SUBARACHNOID HEMORRHAGE, A CASE STUDY

Dear nurses,

Updated 3/24

Updated information for this topic can be accessed by clicking
on the link : 

Subarachnoid hemorrhage

Are you the nurse who has never taken care of a patient with a SUBARACHNOID HEMORRHAGE ?

Well, here is A SUBARACHNOID HEMORRHAGE CASE STUDY that will be of help to you.

ENJOY LEARNING!

You may also enjoy watching the Clinical Videos called SESSIONS, in particular,

try Sessions 7.

HAPPY VALENTINE'S DAY TO ALL NURSES

Updated 12/25

Dear nurses,

New topics and links have been added.

Scenario: Pam has been admitted to the hospital
with complaints of abdominal pain over a period
of time. The doctor has decided to do an ERCP
( Endoscopic Retrograde Cholangiopancreatography)
for this questionable abdominal pain.

This will be reflected in the care plan.

Family teaching is also necessary

Learn more about:
Dehydration on a long flight
Abdominal Aortic Aneurysm

An intravenous infusion may be started in a peripheral
site or a central line site.

Learn more by clicking on the link:
IV assessment

Learn more about : Sepsis

The surgical patient is at risk for infection, related to
  surgical intervention.

- Paralytic ileus may occur .

- Hypothermia due to fluid loss and bodily exposure
  during surgery. Hypothermia increases the body's need
  for oxygen and possibly may lead to a cardiac event.

 Warming measures are necessary.

Learn more about : The spread of infection

WHAT IS WRONG WITH THIS EKG SERIES - THIRD-DEGREE AV BLOCK

Updated 4/24

Dear nurses,

The EKG Series is no longer available.
For more updated information,
please click on the links: 
Chest pain assessment

Heart blocks

Third degree AV block

Transcutaneous pacing is a form of treatment
used to treat patients in Third degree AV block. 

This is considered to be an emergency type of 
treatment, when Atropine is ineffective.

 

  Transcutaneous pacing will help the heart to

beat and improve cardiac output until a permanent

pacemaker is inserted. Patients may need analgesia 

and sedation to keep comfortable, during this time.

 

Updated 10 /24

Cardioversion is a form of shock treatment sometimes

 used for Atrial Fibrillation. It is used to change the heart
 rhythm from Atrial fibrillation to a normal rhythm( sinus rhythm). 

The shock is done on the R wave of the EKG. Typically, it is not
an emergency.

Defibrillation is a form of shock treatment used for
Ventricular fibrillation.This is a life threatening rhythm 

and the shock is done as an emergency.There is usually 

no pulse and the patient is unresponsive.

To learn more about this topic, simply click on the links below:

Chest pain assessment and quiz

and Sessions 18

         

Heart and lungs work together.

Learn about : the ABG and Code Blue

 

IDENTIFYING THE CAUSES AND SYMPTOMS OF THIRD-DEGREE AV BLOCK

Updated 4/26

In third degree AV block, the atria and ventricles,
are beating independently of each other. 

Causes of third degree AV block include:

- MI ( myocardial infarction)

- drugs such as Digoxin , which slows the heart rate

- complications of cardiac surgery

Symptoms include: 

- dizziness, decreased LOC

- chest pain, Shortness of breath

- bradycardia, hypotension and 

decrease in urinary output.

Transcutaneous pacing is a form of treatment
used to treat patients in Third degree AV block. 

This is considered to be an emergency type of 
treatment, when Atropine is ineffective.

 

  Transcutaneous pacing will help the heart to

beat and improve cardiac output until a permanent

pacemaker is inserted. Patients may need analgesia 

and sedation to keep comfortable, during this time.

Learn about : the ABG and Code Blue

Learn more about : The Circulatory System

Scenario: The patient above, was in respiratory distress
and placed  on mechanical ventilation. It is difficult
for the patient on a ventilator to describe pain. Knowing
how to assess is very important.

This topic , including quiz questions continue here:

Mechanical ventilation

Learn more about : ARDS, DVT and PE

Scenario: Nick was admitted to the hospital with a history
of lung cancer. He calls the nurse with complaints of a sudden
onset of shortness of breath and sharp chest pain.This topic
continues : Here

 

IDENTIFYING THE TREATMENT OF THIRD-DEGREE AV BLOCK

Updated 5/24

Dear nurses,

The EKG series is no longer available. Please use the
link :Third degree AV block

for more updated information.

Transcutaneous pacing is a form of treatment
used to treat patients in Third degree AV block. 

This is considered to be an emergency type of 
treatment, when Atropine is ineffective.

 

  Transcutaneous pacing will help the heart to

beat and improve cardiac output until a permanent

pacemaker is inserted. Patients may need analgesia 

and sedation to keep comfortable, during this time.

The heart is always at work. Hemodynamics refers
to blood flow. Any obstruction to the flow of blood
in and around the heart, may lead to failure.

- Myocardial infarction

- Atrial fibrillation

- Lethal rhythms

- CABG

This is unacceptable!

A nurse should always try to seek guidance if unsure what to do.

Hemodynamics refers to blood flow. The heart is a pump,
which pumps blood around the body. If there is damage, 
like a myocardial infarction, the heart's function will be 

impaired. 

Learn more about: Congestive heart failure

Cardioversion is a form of shock treatment sometimes

 used for Atrial Fibrillation. It is used to change the heart
 rhythm from Atrial fibrillation to a normal rhythm( sinus rhythm). 

The shock is done on the R wave of the EKG. Typically, it is not
an emergency.

Defibrillation is a form of shock treatment used for
Ventricular fibrillation.This is a life threatening rhythm 

and the shock is done as an emergency.There is usually 

no pulse and the patient is unresponsive.

To learn more about this topic, simply click on the links below:

Chest pain assessment and quiz

and Sessions 18

         Heart and lungs work together.




 

TREATMENT OF THIRD-DEGREE AV BLOCK

It is important to remember that the treatment of third
degree AV block ,will depend on the severity of symptoms.
The history and physical will also play a role in the course
of treatment to be implemented. 
Always refer to your ACLS guidelines. 

The doctor will also decide whether to use drugs such as Atropine.

For more helpful information on this topic and EKG interpretation,
simply click on the link:

Sessions 16, 17 and 18

Third degree AV block

Updated 4/23

Hemodynamics refers to blood flow. The heart is a pump,
which pumps blood around the body. If there is damage, 
like a myocardial infarction, the heart's function will be 

impaired. 

Learn more about: Congestive heart failure

Cardioversion is a form of shock treatment sometimes

 used for Atrial Fibrillation. It is used to change the heart
 rhythm from Atrial fibrillation to a normal rhythm( sinus rhythm). 

The shock is done on the R wave of the EKG. Typically, it is not
an emergency.

Defibrillation is a form of shock treatment used for
Ventricular fibrillation.This is a life threatening rhythm 

and the shock is done as an emergency.There is usually 

no pulse and the patient is unresponsive.

To learn more about this topic, simply click on the links below:

Chest pain assessment and quiz

and Sessions 18

         Heart and lungs work together.




 

RED ALERT FOR NURSES

Updated 6/25

Learn more about: Your Critical Thinking

HAVE A GOOD WEEK NURSES

Updated 5/25

Dear nurses,

Learn more about : Heart facts and the EKG 

WHAT IS WRONG WITH THIS EKG / FIRST DEGREE AV BLOCK

This graph paper has been enlarged just to make learning the EKG easier. A first degree AV block may be present in athletes and never cause any disruption in the heart's natural
rhythm. To learn more about EKG reading and chest pain assessment, simply click on the link:

http://www.dearnurses.com/

and enjoy WHAT IS WRONG WITH THIS EKG and CHEST PAIN SERIES-MASTER YOUR CLINICAL SKILLS.

There is also a video available for you, simply click on the link:

http://www.dearnurses.com/clinical_nursing_videos_called_sessions

UNDERSTANDING THE HEART AND ITS RHYTHM

For more helpful information on EKG interpretation and cardiac issues, just click on the link:
http://www.dearnurses.com/ and enjoy reading "EKG SERIES-WHAT IS WRONG WITH THIS EKG "and "CHEST PAIN SERIES ," MASTER YOUR CLINICAL SKILLS.

You may also enjoy watching the Clinical Videos called SESSIONS,
in particular watch Sessions 16 through 18

WHAT IS WRONG WITH THIS EKG SERIES / SECOND DEGREE AV BLOCK

Updated 4/26

Scenario: The image above shows someone 

shoveling snow for 30 minutes and develops

chest pain and lightheadedness. Following a
911 call, he was transported to the Emergency 
Room.

This is an example of a cardiac event. History

and physical is a very important part of the 

assessment. Character and the duration of 

the chest pain should also be documented.

Learn about : the ABG and Code Blue

Learn more about : The Circulatory System

Scenario: The patient above, was in respiratory distress
and placed  on mechanical ventilation. It is difficult
for the patient on a ventilator to describe pain. Knowing
how to assess is very important.

This topic , including quiz questions continue here:

Mechanical ventilation

Learn more about : ARDS, DVT and PE

Scenario: Nick was admitted to the hospital with a history
of lung cancer. He calls the nurse with complaints of a sudden
onset of shortness of breath and sharp chest pain.This topic
continues : Here

 

WHAT IS WRONG WITH THIS EKG SERIES / SECOND DEGREE AV BLOCK

Updated 4/26

Dearnurses.com is no longer available.

The image above gives an overview of second 
degree AV block and its causes.

Patients may experience:

- dizziness, decreased LOC

- chest pain, Shortness of breath

- bradycardia, hypotension and 

decrease in urinary output.

Transcutaneous pacing is a form of treatment
used to treat patients  in a second degree AV block,

especially Mobitz type 11. This is considered to be
an emergency type of  treatment, when Atropine is
ineffective.

 

Transcutaneous pacing will help the heart to

beat and improve cardiac output until a permanent

pacemaker is inserted. Patients may need analgesia 

and sedation to keep comfortable, during this time.

Learn about : the ABG and Code Blue

Learn more about : The Circulatory System

Scenario: The patient above, was in respiratory distress
and placed  on mechanical ventilation. It is difficult
for the patient on a ventilator to describe pain. Knowing
how to assess is very important.

This topic , including quiz questions continue here:

Mechanical ventilation

Learn more about : ARDS, DVT and PE

Scenario: Nick was admitted to the hospital with a history
of lung cancer. He calls the nurse with complaints of a sudden
onset of shortness of breath and sharp chest pain.This topic
continues : Here